中药注射液联合低分子肝素预防骨科术后深静脉血栓形成的网状Meta分析  

Network Meta-analysis of traditional Chinese medicine injection combined with low molecular weight heparin in prevention of deep venous thrombosis after orthopaedic surgery

作　　者：唐贵菊 田塬 王继婷 张世波[3] 李亚玲 TANG Gui-ju;TIAN Yuan;WANG Ji-ting;ZHANG Shi-bo;LI Ya-ling(Department of Pharmacy,Ziyang First People’s Hospital,Ziyang 641300,China;School of Pharmacy,Southwest Medical University,Luzhou 646000,China;Department of Scientific Research,Luzhou Hospital of Traditional Chinese Medicine,Luzhou 646000,China;Department of Pharmacy,Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]资阳市第一人民医院药剂科,四川资阳641300 [2]西南医科大学药学院,四川泸州646000 [3]泸州市中医医院科研科,四川泸州646000 [4]西南医科大学附属医院药学部,四川泸州646000

出　　处：《中草药》2021年第14期4289-4306,共18页Chinese Traditional and Herbal Drugs

基　　金：西南医科大学-泸州市中医医院基地项目(2017-LH001)。

摘　　要：目的采用网状Meta分析评价中药注射液联合低分子肝素(lowmolecularweightheparin,LMWH)预防骨科术后深静脉血栓(deep venous thrombosis,DVT)形成的有效性和安全性,以及对患者凝血功能和术后出血量的影响,旨在为临床用药提供循证参考。方法计算机检索Cochrane Library、Embase、Pub Med、Web of Science、中国知网、万方、维普等数据库,收集中药注射液联合LMWH对比单纯LMWH预防骨科术后DVT形成的随机对照试验(randomized controlled trial,RCT),检索时限为建库至2020年12月31日。由2位研究者独立筛选文献、提取数据,并根据Cochrane的偏倚风险评估工具对纳入文献进行质量评价,运用R软件进行网状Meta分析。结果共纳入57项RCT,包含5024例患者,涉及13种中药(丹参川芎嗪、丹参多酚酸盐、银杏达莫、红花黄色素、疏血通、血栓通、血塞通、丹红、丹参、七叶皂苷钠、苦碟子、脉络宁、红花)注射液。网状Meta分析结果显示,与LMWH单纯治疗相比,除血塞通外,其余12种中药注射液联合LMWH均可有效预防DVT形成,排序前3的中药注射液是疏血通(72.2%)>红花黄色素(70.9%)>丹参川芎嗪(66.1%);在降低D-二聚体(D-dimer,DD)水平方面,排序前3的中药注射液是丹红(82.7%)>丹参川芎嗪(76.0%)>苦碟子(74.4%);在降低纤维蛋白原(fibrinogen,FIB)水平方面,排序前3的中药注射液是丹参川芎嗪(92.0%)>银杏达莫(87.0%)>疏血通(57.8%);在延长凝血酶原时间(prothrombin time,PT)方面,排序前3的中药注射液是丹红(85.7%)>红花黄色素(68.3%)>血栓通(68.0%);在延长活化部分凝血活酶时间(activated partial thromboplastin time,APTT)方面,排序前3的中药注射液是七叶皂苷钠(100.0%)>丹红(84.5%)>红花(66.0%);在减少术后出血量方面,疏血通联合LMWH明显优于银杏达莫联合LMWH,排序前3的中药注射液是疏血通(94.5%)>丹参川芎嗪(58.5%)>血栓通(57.9%);在减少不良反应发生方面,排序前3的中药注射�Objective To evaluate the efficacy and safety of traditional Chinese medicine injection combined with low molecular weight heparin(LMWH) in preventing formation of deep venous thrombosis(DVT) after orthopedic surgery and its effect on blood coagulation function and postoperative blood loss in patients by network Meta-analysis, in order to provide evidence-based reference for clinical medication. Methods The databases of Cochrane Library, Embase, Pub Med, Web of Science, Sino Med, China knowledge network, Wanfang and VIP were searched by computer. And the randomized controlled trial(RCT) which traditional Chinese medicine injection combined with LMWH compares with LMWH alone to prevent the formation of DVT after orthopedic surgery, limited from the database to December 31, 2020, was collected. After screening the literature, two researchers independently screened the literature, extracted the data and evaluated the quality of the included literature according to the bias risk assessment tool of Cochrane, and used R software for network Meta-analysis. Results A total of 5024 patients and 13 kinds of traditional Chinese medicine injection [Salvia Miltiorrhiza Ligustrazine(丹参川芎嗪), Salvia Miltiorrhiza Polyphenolates(丹参多酚酸盐), Ginkgo Biloba Dipyridamole(银杏达莫), Safflower Yellow(红花黄色素), Shuxuetong(疏血通), Xueshuantong(血栓通), Xuesaitong(血塞通), Danhong(丹红), Salvia Miltiorrhiza(丹参), Sodium Aescin(七叶皂苷钠), Ixeris Sonchifolia(苦碟子), Mailuoning(脉络宁), Safflower(红花)] with 57 items of RCT were included. The results of network Meta-analysis showed that: Compared with the simple treatment of LMWH, except Xueshuantong, the other 12 kinds of traditional Chinese medicine injection combined with LMWH can effectively prevent the formation of DVT. The top three were combined Shuxuetong(72.2%), Safflower Yellow(70.9%), Salvia Miltiorrhiza Ligustrazine(66.1%) with LMWH, respectively. In terms of reducing the level of D-dimer(DD), the top three were Danhong

关 键 词：中药注射液 低分子肝素 预防 深静脉血栓 网状Meta分析 丹参川芎嗪注射液 丹参多酚酸盐注射液 银杏达莫注射液 红花黄色素注射液 疏血通注射液 血栓通注射液 血塞通注射液 丹红注射液 丹参注射液 七叶皂苷钠注射液 苦碟子注射液 脉络宁注射液 红花注射液 

分 类 号：R285.64[医药卫生—中药学]